Transcription
Hello everyone, it's Miss Gouby. We're going to start out with chapter one in your textbook. This is entitled Phlebotomy: Past and Present and the Health Care Setting. So, for us to get started in this class, you have to know a history of how phlebotomy came about. Um, the word phlebotomy actually means the practice of drawing blood from a vein or through a cut in the skin. And so, we will discuss how this even started.
This slide talks about the objectives. When we say the word objectives, in case some of you don't know, this means what you are to get out of this chapter, what you are to understand from this chapter. So, first, you have to know the knowledge of the terminology that health care settings use. And I use the term health care settings because some of you may end up in a clinic type setting, some of you may end up working in a hospital setting. And the same thing goes for your clinical sites. So, you have to know how these words apply in different places. You also have to know for the national health care organizations that started this phlebotomy, what role that has in us as being a phlebotomist today.
Number two says, describe the basic concepts of verbal and non-verbal communication as they relate to your professional image and telephone protocol in the health care setting. So, I know that you guys understand, like, for example, if someone rolls their eyes, you know that that means they're exasperated or you annoy them. So, that would be non-verbal language. You're not saying anything, but yes, you are saying something. So, that's just one small example. We're going to talk about different things there and different examples.
Number three, compare types of health care institutions and the methods used by providers of health care of health insurance coverage.
Number four, list the personnel levels in the clinical analysis areas of the lab and the types of lab procedures performed in each. So, even though you are going to be the phlebotomist that work in the hospital or clinic setting, you still have to know what those tests mean. Like, what do these tests require? You have to know what color blood tube to draw. You have to know if there are certain requirements for you with that particular tube. Like, does it need to be on ice? Or what does the word "stat" mean? That means it has to go back to the lab right now to be tested. No hesitations. You can't go collect five more people and then take it to the lab. If it's stat, that means it goes right, right then. So, there are things you have to know about, even though you're not actually running the test, you are collecting the samples that are going to be ran. So, you have to do your part in getting the correct sample to the lab to be ran.
Okay, starting out historically in the past, um, the first, you know, Stone Age, as you say, they used crude old kinds of tools to cut veins and drain blood. And so, in the Egyptian tombs, there are paintings. And in these tombs, um, one of the paintings is of a leech. And we'll get into this in just a little bit. But, um, if you don't know what a leech is, it is a blood-sucking little, um, animal. And so, this leech was provided to patients back in the day, old days, in order to do what they called bloodletting. This was usually in Egypt in around 1400 BC. So, bloodletting meant that was one of the ways that they helped treat patients was by putting these leeches on them and help them to drain some of the blood. They thought this was helping. And in nowadays times, they are using leeches again, um, in some of the spas and things like that.
But you do need to know this guy's name. There was a Greek physician named Hippocrates. Hippocrates was in the time frame of 460 to 377 BC. He had a major influence on early medicine. And so, today, he is considered the father of medicine. So, that's what you need to know about him. He is considered the father of medicine because that was so long ago when he started these things. Um, some of the things that he is coined with is even called the Hippocratic Oath. I don't know if you guys have heard of that. But, um, theory says that the Hippocratic Oath stated good health required a balance in the body of four substances: blood, phlegm, black bile, and yellow bile. Okay, these were considered the body humors. And it was thought that disease resulted from an excess of one or more of those substances. And that removing the excess would restore the health. And this is where the leeches came in. So, removing that blood was called bloodletting. And the most common surgical technique for bloodletting was called venesection. Okay, so venesection, at the time, was just cutting a vein. So, this is before needles and all of this. This just meant they cut it. If you break the word down, vena means vein, and section means cutting. So, venesection was cutting the vein with a sharp instrument to release the blood. So, large quantities from a patient, if you're trying to cure or prevent the illness or disease, was very common then. So, they would just cut them to bleed.
So, this venesection, we get this word phlebotomy. And if you are looking at your textbook on page four in chapter one, you can, all of the key points are going to be in blue with an actual key on them. And you can see that that key point says, phlebotomy is the term we use today. And it comes from the Greek words phlebos, which means vein, and tome, which means incision or cut. So, phlebotomy is just another word for venesection, the way they used to do in the old days, which was just cutting the vein. We cut the vein too, as phlebotomists, but we do it with a needle.
Okay, then flash forward a little bit. On the next slide, we get into the Middle Ages, which is the medieval period. This was in Europe and it lasted from the 5th to the 15th century. Surgery was considered a trade instead of a profession. Okay, so they basically just taught people how to do it. They often had no formal training in surgery. And this is something that they ask you on the national registry too, and as well as it will be on your exam. Barbers who were already skilled in using sharp instruments were often called on to perform these bloodletting procedures and other surgical duties. And it's all because they were already used sharp instruments in their barbering skills. So, consequently, barber-surgeons flourished in that time. In 1210, the Guild of Barber-Surgeons had formed in Paris. And this classified surgeons as surgeons of the long robe or surgeons of the short robe. Okay, so you need to know the difference between the two. Short robe surgeons were forbidden by law to do any surgery except just bloodletting, wound surgery, cupping, leeching, shaving, tooth extractions, and even enema administration. Okay, so to distinguish their profession from that of the long robe, short robe barber-surgeons placed a striped pole from which a bleeding bowl was suspended outside the doors of their shops. So, this pole represented the rod squeezed by the patient to promote the bleeding. You do need to know about the pole too. The white stripe on the pole corresponded to the bandages, which were also used as tourniquets. And the red stripe on the pole represented the blood. Then you had the ceramic bleeding bowls, which is where the patients bled into these bowls. Okay, these bowls were passed down from one generation to the next. They also doubled as shaving bowls because they had this little semicircular area on them that were cut out on one side to put the bowl under the patient's chin. If you have your book out, look on that same page on page four. You can see a figure 1-1, which is a picture of a bleeding bowl. So, you see, you just put your chin right in that curved area, and that can be the shaving bowl or the bloodletting bowl.
Moving on from there, in the 17th and early 18th centuries, phlebotomy was considered a major therapeutic treatment process. And anyone willing to claim medical training could perform phlebotomy. The lancet, which was the tool that they used to cut the vein during the venesection, was the most prevalent medical instrument at the time. The usual amount of blood withdrawn was about 10 milliliters. But excess phlebotomy was also common. Like, if they thought you needed to bleed more, then they can do more than the 10 milliliters. If you look in that picture there, you can see the picture on the slide in figure 1-2. These are called fleams. These fleams are the lancets, okay, that they used. So, these capillaries in the area where they cut, they were severed by making a series of parallel incisions with this lancet or fleam. And this is a double-edged blade, okay, at right angles to that handle. There's a double-edged blade, and these were attached and folded into a case that were easy for these, um, medical professionals to carry them around. They were also used to open a vein or an artery to remove large amounts of blood. So, the blades were wiped clean with only a rag. So, you can imagine what kind of diseases they were passing to other patients because all they did was wipe off the blood and then they were ready to go to the next one. That was it. Nothing sanitary about it. So, they obviously transmitted lots of bloodborne infections because there was also a lot of death during that time, and they didn't know how to figure out what was wrong with them.
Okay, there's also a procedure that came about that was called cupping. Cupping is used now, but this is a different kind of cupping. Okay, so it is a, the cupping that involved a heated suction that draws skin, you know, the blood to the surface. Um, in the United States, we do what is called dry cupping, which is cupping without the incisions. And sometimes people do this nowadays. Okay, the suction penetrates deep into the tissues, mobilizing or moving blood flow and causing the tissues to release harmful toxins that can then be removed by the body. Or, if it was back then where they did more wet cupping, this could be, they could do the cupping and then they could cut where the cupping was, like where all that blood flow comes from. They could cut that area and let you bleed out from that area. So, that was one way that they did it then.
Okay, let's look at the next slide. I discussed all of this on the slide before, but this is where they just talk about how they just wipe off the blades and how dry cupping is still done today, but they just don't cut you actually afterwards.
Let's talk about leeches a little more. Leeching, um, back then, it involved putting a drop of milk or blood on the patient's skin. And what this did was entice the medicinal leech to attach to the spot that they wanted you to do the bloodletting in. The leech would engorge itself with blood, which took about an hour, and then the leech would just fall off because it would be so full. But by the mid-18th century, it was widely practiced not only in Europe but also in France. These leeches were kept in special vessels. So, if you're looking at your book again on page five, there's a picture of a leech jar. It kind of looks like just a jar that you would keep flour or sugar in. It's just a jar they had on their counters, but it was a special vessel. It was filled with water and it had a perforated top. So, you can see the little holes in the top, and that's so that the leeches could still breathe. The earliest jars were glass, and then later they became ceramic. Um, in the 1900s, it started declining. But now, medicinal use of leeches has made a comeback since the 1980s as an aid in microsurgery procedures like skin grafts and reattachment of severed limbs and digits. So, they have brought leeches back. They don't have leech jars, so to speak, like that, but they do use them. The leeches, what their purpose is, they suck up pooled blood. They also break up microclots and they promote the flow of oxygenated blood to the area. So, they allow this skin, if you're getting a skin graft, to become oxygenated and help it to live. And as far as attaching limbs and digits, it again brings blood flow to that area.
Where is the therapy though? Um, the therapy in the leech is found in the leech's saliva. Their saliva contains a vasodilator, what that means is that it increases the diameter of the blood vessels. It also contains a local anesthetic, which helps numb the area. And it has an anticoagulant, which is called hirudin, that prevents clotting. And in that picture on the slide, you can see, um, there is a toe that has a leech on it. But that's the biggest thing you need to note from there was when did they take it off? Well, they didn't. The leech was allowed to gorge itself and then fall off.
Okay, let's look at the goals and the methods of phlebotomy today. The goals are to obtain blood for screening and diagnostic purposes and monitor treatment. That is why they need us to draw blood in the hospitals and clinics today. To remove blood for transfusions at a donor center. So, um, if you decide you want to work in a blood donation center, you will have to have a little bit more training at that center because they do use bigger needles than what we teach with. But it's the same process. You are still drawing blood out of a vein. Um, also, we do what we call therapeutic phlebotomy. And this is where they remove blood just for therapeutic purposes. If patients, they can have, um, some diseases called polycythemia vera and also hemochromatosis. And with those two diseases, you have to have therapeutic phlebotomy every so often to be able to treat these patients while they're going through this sickness.
Okay, well, what are the methods we use? We can do venipuncture, which is where you do a needle into this vein and draw out blood. You can do capillary puncture, which is where you do a lancet. You take a little lancet and you slice through the skin. If it's an adult, you're going to do it in the fingers. If it is a newborn or a little baby, you're going to do it on the heel. And this is where you're slicing through and you are getting blood that way. Or, you can draw them if the patient has a vascular access device, which they call VADs. Um, also, they're getting an IV. Technically, they don't like to draw blood out of IV lines because sometimes then they can become occluded or stopped up, and then they have to put in a new IV. And the patient nor nursing enjoys doing this. So, usually they don't do that. But if the patient has a VAD, then they can draw blood through this vascular access device. One group of patients that do have these commonly are cancer patients because they have to have blood drawn so often that they put this device under their skin that's attached to the vein. This is done by the doctor, and then nursing can draw out of this VAD in order to get blood to be able to have it tested.
The changing role of phlebotomists over time. Phlebotomist is anyone trained in blood collection. Okay, so even though you are going through a phlebotomy certification program, you can also be a medical lab technician, and you can be a phlebotomist too. You can be a nurse and be a phlebotomist. So, you can have many different roles. Many different health care team members are trained in phlebotomy. But if you are a phlebotomist and you've gone through the program, then that's when you can take your certification exam and get those extra initials after your name to make you certified.
So, what are the skills you've got to have? Good manual dexterity. You've got to have special communication and organizational skills. You cannot be messy and go into a patient's room and expect to throw everything out there on the patient's bed beside them and then just try to gather your stuff up. You've got to be organized. You also have to know how to talk to these patients. You can't go in there like you do not know what you're doing, like you're not competent. You cannot go in there like you are unsure of yourself. Patients don't want to be stuck by somebody that is a nervous wreck. So, this is why you go through training, you practice, and then you go to clinical, and you practice more. And by the time you finish clinical rotations, when you are finally on your own and you're able to get a job, then you are competent. You are confident and competent. You also, your learning, when you get out of this program, doesn't stop there. You can't say, well, I've learned everything there is to know. I don't need to know anything else. That's not true. You have to stay up to date with standards and technology. Um, if you've ever heard the words continuing education, these are called, you can get these credits. They're called continuing education units, CEUs. And this means that you are going to constantly be learning about any new devices they have for phlebotomy in order to stick patients in a different way. You're also going to be learning about any new testing methods, anything that comes about. Um, you take the opportunity to learn it because the more you learn and the more you are out there doing things, the better you're going to be at your job. And also, the more confidence you're going to have.
Okay, um, lastly, down there, thorough knowledge of lab specimen requirements and of departmental policies. Okay, so you have to know, that's where I'm talking about the specimens. You can't just be blindly saying, okay, I need to draw a red top and a blue top. You need to know what is in those tops. Tops, what, why do they need those colors? What do they mean? What test am I looking for? Um, if the doctor tells you they just want a CBC, you need to know that a CBC means complete blood count. You also need to know that a CBC is drawn in a purple top tube. So, see, this is where this semester you're going to learn this. But you have to know these two. Even though you're not going to go run that CBC, you have to be the one that gets the correct tube in order to run the CBC. Okay, so it's important for you to know all this.
The roles and skills of the phlebotomist. A confident and professional phlebotomist, that's pretty much what you look like. You have a tray. In some hospitals, you have a moving cart that has wheels on it. You have a lab coat. You have your scrubs. You have your tennis shoes. And then you're going to have gloves in your pocket because you're always going to have gloves, or you're going to have gloves on your tray, but you're always going to have gloves that you're going to use too, to draw this blood from the patients. Phlebotomists find that when dealing with patients who are ill or irritable, a competent and professional appearance will be most helpful to them in doing their job. Again, when I said don't go in their room messy, don't go in their room, um, all disheveled without your coat on, without your tray organized, go in there looking professional, acting professional, and you put the patient at ease when you do that.
Typical phlebotomist duties. You're going to prepare patients and the collection site. So, that is your duty to get the patient in the proper position and to decide, decide which site you are going to, which vein, which arm you're going to stick on that patient. It is your duty to collect venous and capillary specimens. To prepare and transport specimens properly to ensure their integrity and their stability. So, again, we are, if anything needs to be on ice, we are not going to just leave it in our tray and take it back up to the lab in a couple of hours because it's obviously not going to be ready anymore. You're going to adhere to HIPAA. If you don't know what HIPAA is, we will have a whole big section on HIPAA because it is extremely important that you do understand about HIPAA and confidentiality. You also need to learn about the institution of the code of conduct and integrity, and you need to follow this code of conduct throughout your whole life as a medical professional. You also need to know about transport, disbatch, and how to prioritize your specimens to ensure their desired, what we call TATs. You need to know what that abbreviation stands for. That stands for turnaround times. You need to comply with safety rules, policies, and guidelines of that particular hospital or clinic that you're working at. And you also need to provide quality customer service. This means listen to your patients. If your patient tells you which arm and which vein that they always get blood out of, then they know. Listen to your patient. Don't think that you know better and you say, no, I'm not going to stick that one, I'm going to stick over here. Patients, if they tell you, no, you can't stick me, you can't go ahead and stick them. That is legally not acceptable. You can get into all kinds of legal trouble by sticking a patient that doesn't give you permission to stick them. So, this is, you know, customer service. Do listen to your patients.
Add additional duties: assisting in collecting, documenting, and recording the workload. The workload means the amount of tests that are coming through in the system for the lab. Perform quality control protocols and instrument and equipment maintenance. You may not ever do that, but then you may do that depending on where you work. So, all this literally depends on what facility you end up working at. Participate in continuing education. This is where I was discussing with you what that meant. This means programs such as online webinars. You don't have to go to school again. You just need to do these webinars that a lot of them are free. You just have to sign up for them. Um, regular safety training. Your hospital or clinic will offer this. Customer service training. And even national certification education modules. So, these are some of the ways that you can get continuing education. Perform POCT. You need to know what that stands for. That is called point-of-care testing. Perform POCT following standard operating procedures. This would be something like bedside glucose testing. Phlebotomists do do that in some facilities. Prepare drafts of lab test procedures for, like, in a standard format, in a nationally recognized standard, and according to whatever facility you work at. Perform lab computer operations and office duties. Instruct patients or customers in container specimen collections. You're going to have to tell a customer, which is, which is your patient, how to collect a 24-hour urine specimen. And we'll get into that later on in the semester. But there are things you have to, cuz you're not going to collect that urine specimen for them, but you may have, you may work in an area that you have to tell them how to collect that sample. It's not as simple as handing them the cup or as handing them the big container for the 24-hour urine specimen. You have to instruct patients how to do it, to do it correctly. And then lastly, train new phlebotomists and students. So, it will be your duty after you finish, once you get a job, to then help train new phlebotomists and students in that area so that you can continue teaching others about what you're doing.
Official recognition. We need to talk a minute about the difference between certification and licensure. Okay, when you finish this program, ICC or Northeast, whichever you're at, they will issue you a certificate of completion. That means that you have successfully completed everything that I've asked you to do, all the tests, all the exams, you've been checked off in lab, you've done your clinical rotations. That means that you have successfully passed the phlebotomy program and you're, you're now a trained phlebotomist. Okay, so that's what you're going to get. The school will offer you a certificate of completion. Now, there are differences there. That's all you're going to get here. And then there is the national certification. National certification is the national exam. There are different agencies that offer this exam. You can have ASCP, AMT, ASPT, NCCT, lots of different agencies offer this certification. This is voluntary, but if you work for certain employers, they may require it. This is why I, I state to all students in this program, you're already studying, you're already taking the test, you're already prepared. So, if you plan to further yourself in this career, I highly suggest you go on and take some kind of national certification while it's all fresh on your mind. It's going to be much harder to finish this program and then three years down the road decide you want to take the certification. Then you got to go back and study all over again. So, if you want to do it, then I suggest you do it right after you finish. It does require a fee and proof that you successfully completed a phlebotomy program that meets the requirements. And so, that's where I come in. I can help you know how to apply, where to apply, what to do. So, if you decide that's what you want to do when you finish, then we need to get it started. It also requires obtaining a passing score on the exam. That national exam. So, depending on which one you take, there are certain scores you have to make. You can't just take it and say, well, I took it. No, you have to pass it. Okay, and after you do that, if you passed it, then they issue you a separate certificate. That certificate, the national one, has a reference number that verifies that you are certified. And it also has a title, gives you a title that is signified by initials that you can display after your name. Okay, so when you finish with this program, if you become certified as, say, ASCP, then you will put the parentheses, PBT, after your title. PBT, and in parentheses, ASCP. If you don't take a national exam, you don't get to put those particular letters behind your name.
There is another thing called a license. Licensure is totally separate from certification. It is different. Licensure means the act of granting a license. Okay, a license in health care is an official document granted by a state agency that gives legal permission for a person to work in a particular health profession. Without a license, it would be against the law for a person to practice that profession in that state. Okay, the license typically, I mean, you know, the individual must meet specific education and experience requirements and pass an exam before the license is granted. The license indicates competency only at the time of the exam. So, this license has to be renewed by either reexamination or proof of your continuing education credits. But good thing for you guys, as of 2023, only four states require a license to be a phlebotomy technician. And those four states are California, Nevada, Louisiana, and Washington. So, most states do not require a license. Mississippi does not. Tennessee does not. Okay, so most of our people that stay in this area, you're fine. You don't have to have a license. But if you go to California, Nevada, Louisiana, or Washington, you will have to have a license from that state.
Let's talk about continuing education in depth a little bit. CE is what continuing education is. What is the abbreviation for CE? This can be any learning activity or course of study that updates your knowledge or skills. It is required by most certifying and licensing agencies for renewal. So, let's say that you finished this program, you take the ASCP certification, you become certified. To keep that certification, you don't have to take another test for ASCP ever, unless you let all that expire. But you do have to keep up your CE credits and send them in. Okay, so this is where CE again is so important. So, once you finish, you're really not finished learning. Um, ASCLS, which stands for the American Society of Clinical Laboratory Sciences, they have an approval process for educational sessions. So, they, the approved sessions are awarded what they call PACE credits. PACE stands for Professional Acknowledgement of Continuing Education. And these credits are accepted by most national certification agencies for your renewal. Okay, so you just send those in. And once those are sent in yearly or every three years, depending on which certification agency you go through, it will, they will tell you how often and how many you have to send in. And as long as you are keeping up with those and sending them in, then you stay certified. And then they have, besides the PACE credit ones, they have other CEs that are just called CEs or CEUs, continuing education credits, which are CEs or continuing education units, which are CEUs. All CE credits are simply just called CEs. That's why they fall under this big umbrella of continuing education.
Moving on to patient interaction. As a member of the lab team, you as a phlebotomist are extremely important in how the lab is portrayed to the public because sometimes they never see the medical lab techs that are working in the lab and running the tests. So, you as a phlebotomist are the face of the lab. Okay, because you're the only one that goes and draws their blood. So, you're the one that they see. So, it is important that, and being the face of the lab, that you want your patient to equate the encounter they have with you with the caliber of care they're going to receive in that hospital. So, this is why it's so important to have empathy because those patients that are there are there because they're sick, or because they're having surgery, or because there is an issue that we don't know about. We don't know what's going on with them. We're there to draw their blood. So, it's important that you have compassion and empathy, that you don't go in there rude or rushing or butting in when they're trying to tell you something. Okay, so it's important that they have a positive customer relationship with you. Okay, so that they know treating everyone the way you would like to be treated, like the good old Golden Rule, that's the best way to be a phlebotomist. That's going to be the best way to put that patient at ease and have a positive relationship so that they relax and you can do your, your job.
Recognizing diversity. There are differences among people that arise from nationality, ethnicity, and culture, as well as family backgrounds, life experiences, and just individual challenges. These differences affect the personal health beliefs and behaviors of both patients and health care providers, including us as phlebotomists. So, we have to be culturally aware of everybody that we encounter. Okay, it's very important that, being culturally aware, this allows us and them to have a much more rewarding experience with our job and with them being in the hospital. Also, it allows you to have greater job satisfaction, which is a great thing. You want to love what you do, and I think you will, as long as you go into work with a positive attitude every day. You also want to help meet the needs of diverse patients with a knowledge of beliefs and values, health needs related to their environment, customs and traditions related to healing, and attitudes towards seeking help. Okay, so it's, it's very important that they recognize that you recognize that there are differences between all of us as humans, but that we all want the same thing, which is goodwill and for them to get better. Okay, that's the, that is our goal. We want everybody to be there to get help, and we want to be the one that makes a positive impression on them to help them.
So, some other things we have to recognize: gender identity. This is the perceived sense of self as being either male or female, both, or neither, that may not be externally visible. Gender expression. This is how one's gender is shown to others through appearance, behavior, and preferred names or pronouns. A pronoun is the word used to refer to someone or something in place of a name. A gender-neutral pronoun is a word that is not associated with gender. Preferred names and pronouns are those that individuals choose for themselves and wish to be identified by. The number of transgender patients has dramatically increased in recent years, and it is important to support them by using proper terminology, preferred names, and pronouns, and any kind of communication strategy that helps. Be mindful of their gender identity. Unfortunately, many of these patients experience stress and anxiety when they visit health care facilities because they have concerns about discrimination before they ever even get there, or previous negative experiences that they've had, such as being required to state a legal name that they no longer use. Explaining that giving their legal name and date of birth is a required part of identification procedure that helps ensure they are treated according to the correct information and medical records, that can help them understand why it's necessary, not that you are trying to back up. These are a couple of gender identity terms that we need to know. Cisgender means the gender that corresponds to your biological sex. Transgender is gender that does not correspond to birth sex, or is neither male nor female. Nonbinary or agender can be transgender or gender non-conforming, neither male nor female. Okay, so those are terms that you need to be aware of.
Qualities of professionalism. Professionalism is defined as the conduct and qualities that characterize a professional person. So, I want you to think about somebody that you think is professional, like somebody in your life that you know is professional. When you think about them, these should be descriptive factors that come to mind. Okay, so as phlebotomists, we have to practice professionalism in every aspect of our work. We have to be professional in our appearance. Okay, um, conservative clothing, meticulous personal hygiene. You should not have any body odor or even too much perfume or lotion. Okay, you should not have body odor or lotiony odor. You can't go to the hospital to work like you might go on a date, for example. You don't want to do that because if you've got patients that are very sensitive to smells, then this is going to be a problem. Okay, so we don't want any odor. We want clean, period. Um, also, health care institutions do require, or I mean, they do make you wear certain scrubs, certain colors, sometimes certain shoes. So, this professional appearance means that your scrubs should not be wrinkled. Don't let them lay in a pile, wadded up, or in your back seat for three days and then, oh, I've got to go to work today, throw them on and you're a wrinkled mess. I don't like to iron, but I do iron. But if I want to do something in a hurry, you can at least throw those scrubs in the dryer for a few minutes to get most of the wrinkles out. Okay, so at least do that. Do not go to work or clinic wrinkled up. Okay, at least make sure that your scrubs are not wrinkled.
You need to have self-confidence. A phlebotomist that has self-confidence and you're able to trust your own judgment. This perception, you have now, there's a difference in cocky and confident. We don't want cocky, we want confident. So, the perception of what you have of yourself, how confident you feel in your job, this perception, they can read it. Okay, patients can read it. And if you appear afraid or timid or nervous, you're going to make the patient anxious and not going to trust you. So, you need to have self-confidence. You need to display this. The more professional you will appear, the more confident you are. So, you need to have erect posture. Don't slump down and walk in there like a cowed down little dog. Make sure that you walk into the room with a confident nature. You need to have professional appearance. Again, that's showing self-confidence. You need to have courage and tactfulness in your communication. All of those are things that have to do with self-confidence.
You need to have integrity. Integrity is honesty and your character. It can be seen in your actions, your values, and your beliefs. Okay, so anybody that has honesty and integrity, this means you're going to do the right thing regardless of the circumstances in all situations and interactions. This means you are not going to do something wrong just because maybe nobody would ever know. You are always going to do the right thing. You've got to have integrity. A phlebotomist with integrity understands following the standards for collection, not drawing tubes out of the wrong order. This is essential to the quality of the test results. And this means the patient, as far as you are concerned, is getting the best quality care.
You have to have compassion. I said this already. This means this is one of the greatest virtues you can have. It is especially important as any health care worker in the entire field. If you don't have compassion, you probably should not be in the health care facility because compassion means you're sympathetic and sensitive to people in need, and you have a desire to help them. So, when you have compassion, you personally feel and take on emotions with the situation of your patient, and you want to reassure them in a caring and humane way. When patients are in the hospital, they're scared, most of the time. So, you showing compassion can help alleviate some of their fear. You don't have to tell them anything that is a lie. In fact, I don't want you to. You don't have to say, oh, I know that this test is going to be perfect, these results are going to be perfect. In fact, don't do that. You don't know that. You don't know that these results are going to be right because right after they're ran, the doctor may have to go give them the worst news of their life. You just need to be compassionate, meaning for their situation. You were there to listen, to draw their blood, and to get out of the room, you know, by being compassionate, but get out of the room and get that back to the lab. So, be calm.
Self-motivated. A person with motivation finds the workplace stimulating, no matter what your tasks are. Motivation is a direct reflection of your attitude toward life. So, if you have self-motivation, this means you're going to take the initiative to follow through on your tasks, consistently strive to improve and correct your behavior, and take advantage of every learning opportunity that is offered. Okay, if you are motivated, that makes every effort to provide excellent care in all aspects of the patient care that you have to deal with.
Dependability. Dependability and work ethic go hand in hand. Okay, individuals who are dependable and take personal responsibility for their actions are refreshing. Working hard and showing constant reliable effort and perseverance is a valuable asset to a health care organization. These qualities make you a desirable candidate for jobs and ultimately promotions. If you are very dependable and have a high work ethic, you will go very far in this field. You will work your way up as far as possible.
Lastly, let's talk about ethical behavior. Ethics is morals, okay, standards, morals, doing the right thing. The distinction between right and wrong. Code of ethics, even though it's not enforceable by law, this does state that you're going to do the right thing. You're always going to do the right thing. The primary objective of any health care professional's code of ethics must always be to safeguard patient welfare. Ethics are centered on an individual's conduct. So, ethical behavior requires conforming to a standard of right and wrong conduct to avoid harming the patient in any way. It requires putting the welfare of the patient before your own needs and making the right choices to maintain a high level of personal respect and respect for your profession.
Patients' rights. All patients in a health care setting have rights and should be informed of these rights when care is initiated. Federal law guarantees the right to privacy of medical records and the ability to get a copy of them. Many states have additional patient protection laws, and most health care facilities have official statements concerning patient rights. In a hospital or outpatient surgery center, you must sign a statement that these rights have been explained, and the signed statement is part of your medical record. The American Hospital Association, which is AHA, we're going to talk about that in a minute, but they have a statement of your rights and responsibilities. So, pretty much, your patient rights, there's laws on them. Patients are allowed to know everything in their records. They're allowed to get a copy, and they have to be explained anything that's happening to them. So, the AHA, the American Hospital Association, they disseminate a statement of patient rights and responsibilities. They have a brochure or pamphlet that needs to be provided if a patient is impatient. And this brochure is called the Patient Care Partnership. It helps patients understand what they should expect during their hospital stay regarding their rights and responsibilities. It states that the first priority of all health care professionals, including phlebotomists, is to provide high-quality patient care in a clean and safe environment, while also maintaining the patient's personal rights and dignity by being sensitive to differences in culture, race, religion, gender, and age. If you look in your book on page 12, there is a box 1-2, and that lists the expectations listed in that brochure. So, you can note that, um, to go back and look at page 12, box 1-2.
Let's talk a little bit more about confidentiality. This is the ethical cornerstone of professional behavior. It serves to protect both the patient and the practitioner. All patient information is private and confidential. As a health care provider, you are bound by ethical standards and various laws to maintain the confidentiality of each person's health information. There is an act called HIPAA, which is Health Insurance Portability and Accountability Act. This requires all health care providers to obtain a patient's consent in writing before disclosing medical information, such as test results, treatment, or condition, to any unauthorized person. It was enacted to secure the information more closely and regulate patient privacy. Safeguarding the confidentiality of PHI. You need to know what PHI stands for. That's Protected Health Information. This is one of the primary aims of the HIPAA Privacy Rule. The law defines PHI as individually identifiable health information that is transmitted by electronic media, maintained in electronic media, or transmitted or maintained in any other form or medium. The law established national standards for the electronic exchange of PHI and states that patients must be informed of their rights concerning the release of PHI and how it will be used. Penalties for HIPAA, they're big. They include disciplinary action, fines, and even possible jail time. So, it's extremely important that you keep patient information private.
Communication skills. Communication is the means by which information is exchanged or transmitted. It is one of the most important processes in the health care system. It involves using words, sounds, writing, or other means to express or exchange information when interacting with one or more people. Effective communication in the workplace can improve productivity, reduce errors resulting from miscommunication, and help organizations run smoothly. The ability to communicate effectively is an extremely important asset to the phlebotomist during interactions with supervisors, co-workers, nursing, physicians, visitors, but especially with your patients.
So, let's discuss interpersonal communication. This means this is between individuals using three main components: verbal, active listening, and non-verbal. So, first, let's discuss verbal communication. This is when the spoken word. Okay, this is the most obvious form of communication. Then you have non-verbal communication. Well, let's talk about active listening. Active listening is true communication. It's not just speaking. Okay, it's more difficult to communicate than just to speak because effective communication requires that the listener participate by focusing on what is being said and giving appropriate feedback. It's a two-way process. So, verbal may just mean you're good at communication in that you can say what's being said, but you're not a good listener. Active listening means you can talk as well as listen. Okay, this two-way process. Then you have non-verbal. 80% of language is non-spoken. You have the process of body language. Let's talk about kinesics and proxemics, the difference. Kinesics is the study of non-verbal communication. It includes characteristics of body motion and language, such as facial expression, gestures, and eye contact. I really want you to look at page 14 in your textbook. Look at figure six. It gives you pictures of a person's face. You should be able to match those up with whether that person is happy, sad, surprised, fearful, angry, or disgusted. That is kinesics, recognizing non-verbal facial cues, body language. Okay, a lot of times we do this unintentionally. Sometimes I've heard people say, my face says a thousand words. Well, be careful, okay, because your face saying a thousand words, what is it saying? If you're looking disgusted or annoyed with your patient, they can tell. So, practice not making those kind of faces when your patient is talking to you. Proxemics. This is the study of an
An individual's concept and use of space. This is a subtle but powerful part of non-verbal communication. It does play a major role in patient relations.
Every individual, every person, we all have an invisible bubble of of our personal space, okay? Where we feel comfortable. The size of our bubble is influenced by things such as our age, our gender, our culture, and even our needs at the time, okay?
There are four categories of territorial zones and the radius of each. You need to look at page 15 in your book, table 14. This shows the zones. It's important you don't have to memorize the actual amounts, but look at the zones. An intimate zone is only 1 to 18 inches away. Personal zone is 1 and 1/2 to 4 feet. Social Zone radius is 4 to 12 feet, and a public zone is more than 12 feet.
It's important as a FLOTUS to be aware of these zones because it is often necessary in the health care setting for you to enter someone's personal or intimate zone. And if you don't handle this carefully, you may make a patient feel threatened or insecure, out of control. So as a flomist, you must work in the intimate zone as you search and palpate. You are touching your patient, okay, to find a vein and perform venipuncture. So you need to make your presence known. Don't just run up there to them and start looking. Make your presence known. State your intentions, establish some rapport with them. Talk for a second before you just jump right in there. Before you enter that intimate zone, be aware that this close proximity to the patient, many other factors come into play that affect this interaction.
Conduct hygiene, grooming, appearance. Again, while we want to make sure we are always clean, we have clean hygiene, we are groomed properly, we have have a clean appearance, okay? All of this is so very important since you have to get into that zone. These dress codes, they're important that you follow the dress code of your facility. Your physical appearance, this also communicates how clean you are, how confident you are, how professional you are. Lab coats, they should completely cover the clothing underneath, and they need to be clean and pressed. Your scrubs should fit well, and your pants should not drag the floor. Shoes should be conservative, clean, polished if applicable, and they should be closed-toed. So you don't want to wear any kind of sandals ever to work.
Pay close attention to personal hygiene. Bathe and use deodorant daily. Do not wear strong perfume or cologne. Keep your hair and nails clean and natural looking. Pull long hair back. If your hair is below your shoulders, it needs to be pulled back into a ponytail or a bun, okay? You don't need to have long hair. Not only is it not look professional in scrubs, it's a hazard because your hair could get in the way. Keep fingernails shorter to ensure safety to not puncture our needle, I mean, our gloves that we wear.
Touch is the last thing under non-verbal. Touching can take a variety of forms and convey different meanings. For example, accidental touching may happen in a crowded elevator. Social touching takes place when a person grasps the arm of another when giving advice. Therapeutic Touch aids in healing. This type of non-verbal communication is very important to the well-being of humans, and even more so to those suffering from some kind of disease. Because medicine is a contact profession, touching privileges are granted to and can even be expected of healthcare workers under certain circumstances. However, whether patients or healthcare providers are comfortable when touching is based on their cultural background. So if you have a patient that is from a different culture, they may not enjoy being touched. So you have to explain what you're doing. When you feel like you need to touch a patient, then usually you need to explain, ask permission first. Otherwise, only touch the areas where you have that specimen collection procedure done, right in that area of their arm. Touch is necessary to do this. So it's important for you to realize that patients are often much more aware of your touch than they are of others. The patient may even question the appropriateness of touching. However, patients usually respond well, and we don't really have any issues, okay?
In this communication, this is the verbal communication loop. So in this loop, you can see that there are barriers. So you've got encoded and decoded. You've got the sender, which is saying something. Then you have barriers in the middle, which are culture, emotions, physical, gender, language, and age. So the message is going from the sender to the receiver. And in the receiver, it's being decoded, and it feeds back to the sender. Like the receiver then says or does whatever to the sender to have that whole communication loop. This is where the loop closes, okay? It goes from the sender to the receiver and back, okay?
Elements of Effective Health Care Communication. We already discussed empathy. Empathy is, remember, identifying with the feelings or thoughts of another person. Control. When you recognize the needs of patients and allow them to express their emotions, you help to validate their feelings and give them a very necessary sense of control at this moment. I've told you, they're scared. Usually. Trust. Trust is defined in the health care setting as the unquestioning belief by the patient that health professionals are performing their job responsibilities as well as they possibly can. Respect and Confirmation. Respect is shown both in a positive feeling for a person and in specific action demonstrating that positive feeling. It's an attitude that conveys an understanding of the importance of that person as an individual. Believing that all people are worthy of respect at some level is extremely important in healthcare communication. If you show disrespect for a patient, the patient cannot help but notice, and this affects the patient's condition in a negative way.
Telephone communication. Telephone is a fundamental part of communication. It's used 24 hours a day in the lab. To them, it becomes just another source of stress, bringing additional work, uninvited demands on your time. The constant ringing and interruption may cause lab personnel to overlook the effect that their style of telephone communication has on the caller. So this can cause stress, but it is possible to step away from that and make sure that you have proper telephone etiquette.
These are the things that you must prioritize. Answer the phone promptly. Don't let it ring 20 times. A lot of facilities have a policy that it must be answered within two to three rings, and that's because they know how disrespectful and unimportant that makes that person on the other end seem. State your first name and department. The caller has a right to know with whom they're speaking. Don't just say yeah or hello. Say who you are and what you're with. Be helpful. Ask how you can be of help to the caller to help facilitate the conversation. Keep your statement simple and to the point to avoid confusion. Prioritize calls. Let callers know if their call is interrupting a call from someone else. Ask permission before putting a caller on hold, in case it is an emergency that must be handled immediately, okay? So say, "This is Shannon in the lab. Uh, can you be, can you hold for one moment, please?" Wait on them to say okay. Transfer and put callers on hold properly. Tell a caller when you're going to transfer the call. Don't just say nothing and transfer it. Learn how to do it properly. If you're unsure, do not ever, ever, ever leave that line open. Don't just lay the phone down, and don't keep the caller waiting too long. Check back with callers who've been on hold for a long time. This keeps them informed of the circumstance. Ask callers who've been waiting on hold for a long time if they would just like to leave a message. Like if you transfer and nobody answers, be prepared to record information when you answer the phone. Have a pencil and paper close to you. Listen carefully, clarifying, restating, and summarizing what you hear. Read back the information when it's finished and see if that's correct. Know your laboratory's policies. Make the answers consistent. When you do that, people who answer the telephone must know the policies to avoid giving the wrong information. Misinformation given to the patient can result in unnecessary worry and additional expense.
Diffuse hostile situations. When a caller is hostile, you might say, "I can see why you're upset. Let me see what I can do." Some of them become angry because of lost results, some billing errors, things that may have nothing to do with you, but you still should try to diffuse the situation. After they've calmed down, usually you can help address the situation. Try to assist everyone. If you're uncertain, refer the caller to someone who can address them.
Written communication. Whether written by hand or typed into a computer, including email, it must be clear, concise, and accurate. It must contain correct spelling, grammar, and punctuation, again, making it professional. Handwritten communication must be legible and written in ink, preferably black ink. That's like the legal part. When documenting events or problems, write them down as soon as possible after they occur and be as precise as possible when recording dates and times. Use work email for work-related communication only. Don't have your Sam's Club membership emails all going to your work email. Save work email only for work. Respond to work-related email in a timely manner, or use use an automatic reply message if you're going to be off work and not checking your email for more than 24 hours. When having important conversations with supervisors or other co-workers, it's a good idea to communicate by email so you have this email trail. It also ensures that this copy is recorded. Similarly, after speaking to a person in person to a supervisor, it is wise to send an email with a summary of what was discussed. This provides a record of the discussion and what was involved. This can be easily fixed if you end up having some kind of miscommunication because you've got a record of what happened and what was said.
Health Care Delivery. There are three main levels of medical care currently delivered in the United States. You've got primary, secondary, and tertiary. Primary involves medical care, care by a doctor or other healthcare professional who is the patient's main source for routine medical care and generally the patient's first contact with the healthcare system. Secondary care is medical care provided by a specialist or facility that has expertise in a problem or concern of a patient who has usually been referred by primary care. Tertiary is highly specialized medical or consultative care that often involves advanced and complex procedures for investigation and treatment of certain disorders or issues. The patient has usually been referred by a primary or secondary healthcare professional. Tertiary care typically involves specialized care within a hospital, such as in a hospital, you have a specialized burn unit or intensive care or cardiac intensive care unit, which is specialized.
There are two general categories of facilities. You have ambulatory, which is outpatient, and non-ambulatory, which is inpatient. And those support all three levels of the care, okay? I do want to make note of something on, let me find it really quick, okay? On page 25 and 26 in your textbook, you will see a list of different medical specialties. So I would like for you to look at these specialties and their area of interest and their titles. I'd just like you to be familiar with these different specialties because you were liable to hear them at some point in your life, even if you don't hear them as being a flomist. Also, look on page 26 and 27, table 1, and this is a list of the different hospital services and departments, and I want you to also take a look at those departments as well as what services they perform, okay?
Ambulatory Care. This is medical care delivered on an outpatient basis. There are two types: freestanding medical care settings and hospital-owned clinics. And then you have outpatient departments and urgent care facilities. Observation, diagnosis, treatment, and rehab can all take place in those two types of facilities. Then you have homebound services. These homebound services happen either in a patient's home or in long-term care facilities.
Public Health Service. This is another way of delivering healthcare to people in the United States. The mission of this primary division is under the Department of Human and Health Services, and it is to promote the protection and advancement of the nation's physical and mental health. It does so by sponsoring and administering programs for the development of health resources, prevention and control of diseases, and dealing with drug abuse. PHS agencies at the local or state level offer defense against infectious diseases that might spread among the population. These agencies monitor, screen, protect, and educate the public. Then you have public health departments, which provide their services for little or no charge to the entire population of a region, with no distinction between rich or poor, simple or sophisticated, interested or disinterested. Public health facilities offer ambulatory services through clinics like those in hospital outpatient areas, military bases, and Veterans Administration and Indian Health Services, okay?
In health care financing, we have the Affordable Care Act. This act aims to provide the consumer with insurance options and increased accessibility to affordable health care. You have third-party payers. These can be an insurance company, the federal government, a managed care program, or a self-insured company that pays for health care services on behalf of its employees. These payment methods used can be either direct or indirect payments to the provider by the patient are called direct pay, self-pay, or out-of-pocket pay. Indirect pay means a third party other than the patient or healthcare provider, which is the second party. Some healthcare providers are even beginning to contract directly with employers to provide healthcare, eliminating insurance carriers altogether. Third-party payers have greatly influenced the direction of medicine, diagnosis, and billing codes. The Current Procedural Terminology, which is CPT codes, were originally developed by the American Medical Association to provide a terminology and coding system for physician billing. Physicians' offices have continued to use it to report their services. However, now all types of healthcare providers use CPT to classify, report, and bill for a variety of healthcare services. When the ICD, which is the International Classification of Disease, became available for use in inpatient settings, the CPT codes remained the codes used by doctors for reporting procedures in ambulatory settings and for the professional services in inpatient settings. So if you look on table 17, which is on page 22 in your textbook, this tells you the difference between ICD codes, CPT codes, and HCPCS codes.
Reimbursement entitlement programs. This is Medicare and Medicaid. Medicare, if you don't know, make sure you know the difference. Medicare primarily serves individuals over age 65 and certain younger individuals who are disabled or on dialysis. And then Medicaid is an assistance program that serves low-income individuals of any age. Although Medicaid is a federal program, each state is responsible for sharing the cost and administering the Medicaid funding at the state level.
Accountable Care Organization. Healthcare systems are currently undergoing major revisions because of an environment that many see as fragmented and wasteful. The driving force behind these changes is the ever-increasing demands on healthcare services to deliver patient-centered care and improve outcomes at a much lower cost. One of the goals of the Accountable Care Organization was to streamline the delivery of healthcare by reducing duplication through a new kind of care offered by this Accountable Care Organization. An ACO is a network of hospitals, physicians, and healthcare providers who voluntarily offer to coordinate care for their Medicare patients. The providers jointly are accountable for this healthcare, which gives them financial incentive to cooperate and share information to avoid unnecessary tests and expenses. So this helps keep a patient from having a bunch of duplicate testing.
This is called managed care, okay? This is managed care. It's a generic term for a payment system that strives to control cost and access to healthcare and strives to meet high quality standards. All healthcare organizations and services find that they must do more with less and have implemented some form of managed care to survive, okay?
What is a case manager? It is the primary care provider and what we call the gatekeeper, whose responsibility is to coordinate all of a patient's healthcare. The case manager is an experienced, licensed healthcare professional, not necessarily a physician, who knows the patient's condition and needs and where available resources for support and treatment can be found. So you're the patient's advocate. This person has the responsibility to advise the patient on healthcare needs and coordinate responses to those needs. The responsibilities of the case manager include providing early detection and treatment of disease, which can reduce the total cost of their care.
Managed care organizations, and Health Maintenance Organizations, and Provider Preferred Provider Organizations. These are network service systems, all of these, okay? So HMOs, which are Health Maintenance Organizations, they are health plans that have a network of doctors, hospitals, and other healthcare providers. These are referred to as in-network providers. So these HMOs will restrict you to a network of providers and require you to see your primary care first. If you need to see a specialist, you have to have a referral to an in-network specialist. If you go outside of network, you're usually not covered, or you'll pay a higher portion of the cost. PPOs, these are health plans that have a large network of providers. However, you can see a specialist without a referral with certain exceptions and go to a doctor outside of your network, although the coverage may be less. PPOs have higher premiums and out-of-pocket costs, okay?
Clinical Laboratory Services. The lab is where they perform the tests on the patient specimens. The results of the tests are sent to the physician to help aid in diagnosis, evaluating or monitoring your patient, helping them get well. Ultimately, clinical labs are typically located in hospitals, large reference labs, and outpatient clinics. However, advances in lab technology have made point-of-care testing common, and services that were once unique to the lab are now being provided at many other locations.
So let's talk about the people in the lab. At the top of the totem pole, you have the lab director or pathologist. The pathologist is normally a physician with advanced training in clinical and anatomical pathology. This individual specializes in diagnosing disease using lab test results and analyzing tissue removed during operations and from postmortem examinations, doing autopsies. The pathologist's duty is to direct lab services to benefit both physicians and patients. The lab director may be a pathologist, or they may be a clinical laboratory scientist with a doctorate. The lab director and lab administrator share responsibilities for managing the lab. The lab administrator is usually a medical technologist, which is also called the lab manager, with an advanced degree and several years of experience. Duties of the administrator include overseeing all operations involving physician and patient services. Today, the lab administrator may supervise several ancillary services such as radiology and respiratory therapy, or all the laboratory functions in a healthcare system that consists of separate lab facilities across a large geographic area.
The technical supervisor. Each laboratory section or subsection has a technical supervisor who is responsible for the administration of the area and who reports to the lab administrator. This person usually has additional education and experience in one or more of the clinical lab areas. Then you have the MT or MLS, which is the medical laboratory scientist or medical technologist. Generally, they have a Bachelor of Science degree plus additional studies and experience in the clinical lab setting. Some states require licensing for this level of personnel. The responsibilities of the MLS include performing all levels of testing in any area of the lab, reporting results, performing quality control, evaluating new procedures, and conducting preventative maintenance and troubleshooting on instruments. Then you have the MLT, which is a medical laboratory technician. This is most often an individual with an associate's degree from a two-year program or certification from a military or private school. As with the MLS, some states may require licensing for MLTs. The MLT is responsible for performing routine testing, operating all equipment, performing basic instrument maintenance, recognizing instrument problems, and assisting in problem-solving. Then you have the medical laboratory assistant or MLA, also called the clinical laboratory assistant or CLA, or also called the clinical assistant or CA, because all depends on where you work. This is an individual with phlebotomy training, so this could be you with a little more experience or experience who are skilled in many areas of the lab, including registering patients and collecting, transporting, processing, and determining suitability of blood and non-blood specimens for analysis. The MLA may also make slides, prepare reagents, standards, and controls, perform waived or other tests at the MLA level, and assist the MLS or MLT with the workload. So when I was explaining to you about professionalism, ethics, you know, whether you have a high degree of wanting to do better, always wanting to learn, your integrity is high, this is where a lab may choose to ask you if you want to be trained a little further and become a medical laboratory assistant. It is a pay raise in most places. So this would be you as a phlebotomist with a little more experience training at the hospital lab, you would get a different title and most of the time a pay grade, a pay increase, okay?
What is a phlebotomist? A phlebotomist is trained to collect blood and certain other specimens for lab tests that are necessary for the diagnosis and care of patients. Some facilities train phlebotomists as lab assistants, as I said, or specimen processors. Most phlebotomists have received a certificate of completion from a formal phlebotomy program, but some have been trained on the job. Many become nationally certified by passing a national examination from one of several national certifying agencies.
Other laboratory personnel. Other positions in the lab may include a LIS manager, which is a Laboratory Information System Manager. What they're going to do is oversee the upgrades and maintenance of software and hardware. You may also have a quality and compliance coordinator, who oversees procedures, policies, and processes for continuous quality improvement. You may have a point-of-care supervisor, who works closely with the nursing staff and outpatient services personnel to ensure the POC results are correct and that the maintenance and QC checks on POC instruments are performed correctly by the operators of the instruments. You may have an education coordinator, who oversees any students who do their clinical practicum in the laboratory. It's the coordinator's job to verify student credentials, to ensure that they meet the facility's health and safety requirements, and to generally serve as a gatekeeper for anyone wishing to intern in that area. They also provide educational activities and CEUs for the lab personnel. And then lastly, you might have a supervisor of support services, such as phlebotomy and central processing, who make certain that all specimens are correctly collected, received, and prepared for testing. They provide phlebotomy and central processing staff with training, technical direction, training support, and resolution of problems that arise in the lab on a day-to-day basis.
Traditional Clinical Laboratories. Clinical laboratories generally have two major divisions. You have the clinical analysis area. This is the largest area of the lab and it performs the majority of tests, consequently producing the majority of test results. Most of the tests in this area are performed on blood and other body fluid specimens. And then you have the anatomical and surgical pathology area. And this area is the area where most of the tissue analysis occurs. Cytology happens there, surgical biopsies, frozen sections, and autopsies happen in this area. All lab testing is associated with one of these two areas. Similar tasks are grouped into departments. The goal being to perform each task accurately, efficiently, and cost-effectively.
This is a flow of how the Clinical Laboratory side is branched out. You start out with the lab administrator or director at the top. Then you have each supervisor or director underneath there. And then underneath the lab administrator, you can also go straight down and have quality and compliance coordinator and support services. So this is a flowchart to show you each area.
Clinical analysis areas. This is where you need to be familiar with each area in the clinical side. You have chemistry. Chemistry detects and measures chemical substances in body fluids. Um, this department typically performs the majority of lab tests. That is a picture of some examples of chemistry tubes and plasma tubes. Next, you have hematology. This is the study of the blood and blood-forming tissues. This performs lab tests that discover, identify, and monitor disease and other problems associated with blood and blood-forming tissues. Most hematology tests use lavender or purple top tubes, as you can see in the picture. Next, we have coagulation, which is the study of the blood's ability to form and dissolve clots. Coag tests are closely related to hematology tests because they're used to discover, identify, and monitor defects in the blood clotting mechanism involving formed elements in the blood called platelets. This is, um, usually a part of the hematology department or close by, and they use light blue or blue top tubes. Next, we have immunology. Immunology involves the study of the immune system, and serology involves the study of serum, which is the part of blood that you're testing for the immunology area. Serology tests identify antibodies and antigens in serum that are the body's response to the presence of bacterial, viral, fungal, or parasitic diseases. Immunology tests investigate immune system problems such as autoimmune reactions, where the autoantibodies produce B lymphocytes that attack our normal cells. You can see in the picture, there are red and yellow and gold top tubes in that area. Then you have microbiology. This analyzes blood and other body fluids and tissues for the presence of microorganisms, primarily by means of culture and sensitivity testing. A culture is where you grow out and identify an organism, and sensitivity is where you identify the antibiotics that will be effective against that particular organism. And the blood, if it goes back there, that is a picture of blood culture bottles that you will draw that get sent back to the micro department. And lastly, we have blood bank. Blood bank is also called immunohematology. This is where the department prepares blood products to be used for patient transfusions. Blood components dispensed include, you can have whole blood, platelets, packed cells, fresh frozen plasma, and cryoprecipitates. Blood samples from all donors and the recipients have to be carefully tested before transfusions so that incompatibility and transfusion reactions can be avoided. Typically, they want a pink top, or they can use purple tops and red tops as well, but the pink top is, you know, the favorite, okay?
In these areas, let's talk about urinalysis. Urinalysis is abbreviated UA, okay? This is the analysis of urine, so you're testing urine samples. Cytogenetics. Cytogenetics samples are examined for chromosomal deficiencies that relate to genetic disease. Flow cytometry. This is also used for clinical trials and in research to analyze and sort cells. Then you have molecular. Molecular Diagnostics analyze biological markers in the human genome. This is a picture of a medical laboratory scientist loading a cytometry analyzer with tissue samples for HLA testing.
Now let's move to the anatomical side. Anatomical, remember, was the other side, side, not the clinical side of the lab. You have on the anatomical side, you have histology. Histology is defined as the study of microscopic structure of tissues. In this department, pathologists evaluate samples of tissue from surgeries and autopsies under a microscope to determine if they're normal or diseased. Two of the most common techniques used to obtain histology specimens are biopsy of tissue or frozen section, where you take it from surgery, freeze it, and then examine it while the patient is still in the operating room to see if you need to do more surgery. Cytology and histology are often confused, but they're different. While histology is concerned with the structure of tissue, cytology is concerned with the structure of cells. So in this department, cells and body tissues and fluids are identified, counted, and studied to diagnose malignant and premalignant conditions. Histologists often process and prepare the specimen by a pathologist or technologist. Excuse me, histotechs prepare the specimens to be evaluated by a pathologist or cytotechnologist. The Pap smear is a test for cancer cells in females, and this is cells in the cervix. This is one of the most common examinations done in the cytology department, okay?
Let's talk about satellite and reference labs. In today's rapidly changing environment, some lab services and large tertiary facilities had to set up satellite labs. These specialized labs are located close to the populations they serve to facilitate better outcomes for the patients by drastically reducing turnaround time for the test results. Examples are a neonatal intensive care unit lab, or NICU lab, in the newborn intensive care unit. This is a critical care lab located close to the operating room also, and the recovery room. And also, we have a stat lab in the emergency department. So each satellite lab has a test menu designed for its specific population. Tests performed in these labs are those needed to respond to medical emergencies, such as a microscopic exam of a newborn's blood in the ICU. Many hospital labs have become primarily stat labs, outsourcing most non-critical testing to reference labs. And in saying that, what is a reference lab? Well, it's a large, independent lab that receives specimens from many different facilities located in the same city, or even other cities in the same state, or even cities that are out of state. They provide routine and more specialized analysis of blood, urine, tissue, and other patient specimens. One of the benefits of sending specimens to a reference lab is that the cost per test is reduced because of the high volume of tests performed at that site. So reference labs offer stat testing, but because it's offsite, the turnaround time cannot compare to on-site labs. So specimens sent to offsite labs have to be carefully packaged in special containers because it has to protect the specimen and meet federal safety requirements to transport a human specimen.
These are just entry-level competencies that need to be met in this chapter. So this means that if you glance through these, you should be able to answer what these competencies are. If you have any questions, please email me and feel free to ask, or I can put a discussion board up so that you can ask it in the Canvas course. And if you don't have any questions, then your homework will be listed below this, below the link to this slide show. And, um, I will see you next time. Thank you for listening.